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Today, there are essentially two endoscopic approaches available to address inflammatory or neo-plastic disease of the ethmoid, maxillary, and sphenoid sinuses: the anteroposterior (AP) approach and the posteroanterior (PA) approach.^1–4

The Anteroposterior (AP) Approach

Anteroposterior exenteration of the ethmoid sinuses is the technique most widely used in the United States.^1,2 In this approach, the surgeon begins with an anterior ethmoidectomy by removing the unci-nate process, bullar cells, agger nasi cells, and occasionally entering the frontal recess. The surgeon then proceeds as far posteriorly as needed to remove the diseased ethmoid cells and polyps and to establish drainage to the dependent sinuses that are blocked. A limited maxillary antrostomy is typically not performed until after most ethmoid cells have been addressed. If a sphenoidotomy is indicated, a transethmoidal operation through the common wall of the sphenoid and posterior ethmoid sinus is performed.

Proponents of the AP approach argue that this technique enables the surgeon to address anterior ethmoidal disease without the need for extensive surgery.^1,2,5 Not all surgeons share this view, however, arguing that patients frequently have pansinus disease affecting not only the anterior ethmoid’s dependent sinuses (maxillary and frontal) but also the sphenoethmoidal recess and surrounding ostia draining the posterior ethmoids and sphenoid sinuses.⁶

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